Looking Inward and Reaching Out to Solve Health Disparities

Someone living in downtown Chicago can expect to live to be about 85. But go seven miles south or west, and that age drops by 10 years or more.

“When audiences
start to think about the cause, they think of violence — because they hear all
about gun violence,” said Dr. David Ansell of Rush University Medical Center on
Chicago’s West Side.

But the actual No. 1 and No. 2 causes of death in those communities are cancer and heart disease, Ansell said. “So you have to say, what’s the root cause? Poverty. And poverty is something that’s been imposed.”

People on
Chicago’s south and west sides are getting sick more often and dying younger
because social factors limit their ability to get healthy food, make a living
wage and get around safely.

Ansell discussed
the root causes that impact health during a panel presentation at MATTER, a
health care incubator in Chicago. He was joined by James Williams and Dr.
Thomas Fisher, both of UChicago Medicine, and Jessica Hager of Feeding America, a network of 200 food banks across the United States. The panelists
described how their organizations are working to address social determinants of
health.

Look inward

Hager said
efforts aimed at addressing health disparities too often focus on trying to get
people to change their behavior. They’re chided for using the emergency room —
regardless of whether they have access to primary care. They’re told they
should eat healthier food but there may be no grocery store in their neighborhood.

“To put the onus on the individual is problematic,” Hager said.

Organizations
are beginning to realize they need to make their own systems work better for
their communities.

Ansell noted
that many institutions have systems in place that may perpetuate poverty or
inequality.

Society created it. Therefore, you have the ability to change it.

In that vein,
Rush examined how its own practices could affect health equity. It found
entry-level workers in some jobs were not making a living wage. They could work
at Rush for 30 years and still retire in poverty.

“It required us
to look inward at our own policies on advancing low-wage employees,” Ansell
said. “If we can’t get it right here, how can we get it right in our
communities?”

As part of that
effort, Rush started two new career pathways in 2018. One, a pathway for
medical assistants to become nurses, had 300 applicants in the first week.

Reach outward

Those committed
to taking on health disparities are also reaching out — to individuals and to
communities.

Williams
described a pilot program of the Urban Health Initiative at UChicago Medicine that sends
community health workers into the homes of children with asthma. They provide
resources and support in addition to teaching kids and their parents how to
better control their condition. It has resulted in fewer missed days of school
and work.

“We need to meet
patients where they are and provide what’s necessary to change some of those
behaviors,” Williams said.

Another outreach
effort underway through the Urban Health Initiative addressing intentional
violence is the Southland Health Equity and Innovation Collaborative between
UChicago Medicine and Advocate Christ Hospital. SHEIC aims to reduce mortality
related to intentional violence and increase life expectancy for people ages 18
to 30 in targeted communities.

Ansell stressed
the importance of “respecting the voice of the community.”

Rush and three
other health care institutions are part of a collaborative called West Side United.

The health care
providers are working with businesses and community and faith-based
organizations to make the neighborhoods healthier. West Side United’s goal is
to close the life-expectancy gap for residents by half by 2030.

Solving the web
of problems behind health disparities may seem overwhelming at times. When that
happens, Fisher said he keeps these words in mind: “Society created it.
Therefore, you have the ability to change it.”

In that vein, Blue Cross and Blue Shield of Illinois recently issued a nationwide Health Equity Innovation Challenge to help close the gaps for members who are facing social, cultural and economic barriers to care. The insurer offered the top three finalists cash prizes and a six-month membership at MATTER, while the winning team has an opportunity to pilot their solution to advance health equity with BCBSIL’s in-house incubator.

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